HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 I- I - ;L1 Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Form Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial
CBDG Funding
Residential Y
PERMIT APPLICATION FOR: fie,chQn i c�
PROPOSED IMPROVEMENT LOCATION:
-Address: �O�� Ne}�I25 f�IJ ParCej mod. k5d1-5�1 Oggb-coo -"7
Property Tax ID #:
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Lot No._
Block No.
C,,aPcje out- 3 +on Pa1jhfSf cad I p aNru f- w Kee.+e,r
like oaf 11 ke
New Electrical Meter Second Electrical Meter (Affidavit required)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
— Electric _ Plumbing J Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ g600 .610
_ Generator
Sq. Ft. of First Floor:
Windows/Doors _ Pond
Roof Pitch
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name DCfo-'h ANc I0alr' roi
Name: VOLAct R. CUTji n -
Address: to t 0 NOt1 e5 6.1 'Jd,
Company: Dodd E Ai-e,rrises -Z7&C
City: sense^ r>QAC ' State: _
Zip Code: _3gg57.7 Fax:
Phone No. 71 aL - E-
Address: DA 6 3e 61J
City: Port- &� %kz1'e State: 1~1
Zip Code: 31q 5'a Fax: 335 • ��
Phone No 3q % - %-3Ltq
E-Mail a0JJ tA-�trp rt'S6 dd Corr►
Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License [MC (3.ggSg
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
if value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.